Monday, 21 May 2012

37 weeks ~ final plans

I had been quite worried about giving birth before my London epilepsy appointment as were the doctors at Epsom I think, but luckily baby had held on so Rich and me headed up to London.  We met Emma up there, it was great she came, was good to have her ask questions from a midwife point of view.  As always my specialist was brilliant and a clear plan was made:

  • An IV should be put in as soon as I get to hospital
  • Everyone involved should be aware of my epilepsy
  • Diazepam or Lorazepam should be drawn up and in the room and the hospital seizure protocol should be followed
  • To take 10mg Clobazam 12 hourly from when I arrive in hospital
  • Can have all forms of pain relief including TENS and Pethidine
  • To have epidural early to manage pain and in case of emergency caesarean being needed
  • Low threshold for caesarean
  • Reduce Lamotrigine dose to 450mg straight after birth
She was really good at coming up with a plan but also respecting the decisions of the doctors at Epsom hospital too.  I asked about whether I had to go into hospital as soon as I went into labour as didn’t want to be stuck on a ward on my own without Rich and also whether I had to stay in longer than any other person.  She said that at the end of the day it has to be what Epsom doctors decide but that she doesn’t feel I need to be in hospital any more than anyone else.  I also briefly brought up the possibility of changing my medication to Keppra in the future as I felt my dose was very high and since being pregnant and with lower levels I have felt less tired and with the added risk of birth abnormalities in higher doses I was seriously considering a change in medication.  We agreed to consider this again when we are in a routine with the baby.

After the appointment we went for lunch with Emma to discuss everything.  Emma is amazing, so organised, she said she would find my notes next time she’s in and make sure the hospital epilepsy protocol and a plan for my care was in the front of the notes.  It made me feel so confident knowing my notes were in order and communication was occurring between both hospital teams.  We also discussed Emma’s role, having known her since we were 2 we decided that the midwife would do internal examinations but Emma would do the rest of my care and deliver the baby.

I haven’t really spoken about how I was feeling about everything, I had been trying not to think too much about the labour until the London appointment, although my first anti-natal class had worried me a little.  After this London appointment I was feeling a bit more confident as I felt I had a plan, but at the same time it was becoming very real and the fear of what could go wrong was there and then also how daunting it is to have to be in a very vulnerable and awkward situation.  Everyone says when you’re in the situation you lose all sense of embarrassment but I couldn’t believe that… but looking back now, they were right!

I also had my anaesthetic appointment, they examined my spine and decided it appeared they could get an epidural in.  We decided that I would have an epidural early on, both to manage my pain which could trigger a seizure and also to avoid the risk of me having to have a general anaesthetic if I needed an emergency caesarean if, for example, I had a seizure.  We also discussed Pethidine, I had decided I didn’t want it anyway as both my Mum and a few other people had said it didn’t help the pain just makes you feel you’ve lost control, the anaesthetist said hospital policy was that they don’t usually give it to people with epilepsy anyway.

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